Basic Information
| Provider Information | |||||||||
| NPI: | 1497799308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BURKE | ||||||||
| OtherFirstName: | BILL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 487 | ||||||||
| Address2: | KELLER FAMILY MEDICAL CENTER | ||||||||
| City: | KELLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762440487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174312573 | ||||||||
| FaxNumber: | 8173796881 | ||||||||
| Practice Location | |||||||||
| Address1: | 808 KELLER PARKWAY | ||||||||
| Address2: | |||||||||
| City: | KELLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174312573 | ||||||||
| FaxNumber: | 8173796881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G3197 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.